Abstract
Central conducting lymphatics (CCLs) disorders represent a broad spectrum of clinical entities ranging from self-limiting traumatic leaks treated by conservative strategies, to complex lymphatic circulation abnormalities that are progressive and unresponsive to currently available treatments. Dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) performed by intranodal injection of gadolinium-based contrast material is a recently developed technique which allows a minimally invasive evaluation of the CCL abnormalities providing a dynamic assessment of lymph flow and its pathways. In our institution, DCMRL is performed after bilateral cannulation of inguinal lymph nodes, using a MR protocol which includes volumetric 3D T2-SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolution) and free-breathing respiratory navigated sequence and TWIST (time-resolved angiography with Interleaved stochastic trajectories) MR angiography sequence, during intranodal injection of paramagnetic contrast medium. Although DCMRL applications in clinical practice are still improving, a minimally invasive assessment of lymphatic pathways is particularly important both in pediatric patients with primitive lymphatic system disorders and in children with complex congenital heart disease associated with CCL impairment.
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Acknowledgements
All authors are sincerely grateful to the entire Cathlab/MRI personnel, in particular nurses and radiographers, and to the Airway Team led by Sergio Bottero for their support in the management of patients suffering from plastic bronchitis. Thanks are due to Gabriele Bacile for filming procedures.
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Bordonaro, V., Ciancarella, P., Ciliberti, P. et al. Dynamic contrast-enhanced magnetic resonance lymphangiography in pediatric patients with central lymphatic system disorders. Radiol med 126, 737–743 (2021). https://doi.org/10.1007/s11547-020-01309-5
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DOI: https://doi.org/10.1007/s11547-020-01309-5